A reviewer for the state health care commission has reaffirmed his position that Anne Arundel Medical Center should have a cardiac surgery program.

This revised recommended decision, released Friday, will replace the one Dr. Craig Tanio released Dec. 30, where he denied Baltimore Washington Medical Center and wrote in his recommendation memo that AAMC "has the highest potential for establishment of a lower charge cardiac surgery program that will also be high performing."

The two hospitals submitted applications for a cardiac surgery certificate of need in February 2015. The Maryland Health Care Commission was scheduled to make a final decision Jan. 26, but pushed the decision to a later time to allow the hospitals the chance to respond to data used by Tanio in his recommendation. The decision will now be made at the commission's meeting on March 23.

"We stand united in asking the Maryland Health Care Commission to continue to keep the needs of citizens...

(Meredith Newman)

Tanio wrote some information used in the original memo "should have been provided to the parties with sufficient time for them to comment on this information prior to the commission's consideration of my recommendation." He added that he made some changes in the updated recommendation, but those didn't alter his overarching findings or recommendation.

BWMC, Dimensions Health Corp., the parent company of Prince George's Hospital Center, and MedStar Health filed papers in January, asking the MHCC to reject the recommendation. Among its many grievances, the hospitals felt there wasn't enough time to review the statistics Tanio first included.

This winter, County Executive Steve Schuh wrote to BWMC asking officials to withdraw its challenge to the recommendation. Senate President Thomas V. Mike Miller and the Prince George's delegation held a press conference about how a cardiac surgery program at AAMC would hurt the upcoming Prince George's Regional Medical Center.

House Speaker Mike Busch is a member of the University of Maryland Medical System's board of directors and has been a public supporter of an open-heart surgery program at AAMC.

In Tanio's December recommendation, he listed three conditions for AAMC to follow if the commission's approves the CON application. Tanio included an additional condition in Friday's recommendation, in which AAMC's cardiac surgery program and its surgeons participate in the Society of Thoracic Surgeons National Database. He wrote that the hospital should send the data it submits to the society to the MHCC. The commission can then use this information in an on-going review of its cardiac surgery program, he wrote.

Like in his previous recommendation, Tanio restated that he believes only one cardiac surgery program should be created at this time. While both hospitals could "develop a safe and clinically competent program" and reduce cardiac surgery charges for patients, Tanio said he went with the "most prudent approach."

"The approval of two new cardiac surgery programs at the same time could risk the creation of two low volume, underperforming programs that could require ongoing corrective actions by the commission, possibly leading to closure of one or both programs," he wrote.

But, Tanio wrote that this shouldn't prevent BWMC from reapplying for a CON application in the future when there is "concrete evidence of the impact on the movement of cardiac surgery volume from a high cost center to a lower cost center on cost, quality and access."

He added that if the commission accepts his revised recommendation, the MHCC should collect this "impact information and monitor the impact of AAMC's cardiac surgery on cost, quality, and access and report this impact to the commission on an annual basis for the next four years."

BWMC officials said in a statement Monday that they are "disappointed" with the revised recommendation. AAMC, BWMC and other interested parties can respond to Tanio's recommendation by March 10.

"We continue to feel strongly about the merits of our application to perform cardiac surgery at UM BWMC, and look forward to addressing the commission on March 23," hospital officials said.

AAMC said in a statement that hospital officials "appreciate Dr. Tanio's thoughtful review of this project," specifically that he once again finds the hospital to be the best location for a cardiac surgery program.